Beyond the Mainstream: Unlocking the Power of CM and CRA in SUD Treatment

Understanding Contingency Management (CM) and Community Reinforcement Approach (CRA)

  When it comes to treating Substance Use Disorders (SUD), it’s essential to consider a range of evidence-based approaches that can cater to diverse individual needs. While some treatment modalities receive more attention, there are lesser-utilized yet highly effective approaches that deserve recognition. In this article, we will delve into two such approaches: Contingency Management (CM) and Community Reinforcement Approach (CRA). By understanding the principles and benefits of these methods, we can broaden our understanding of effective SUD treatment options.

Contingency Management (CM)

Contingency Management is a behavior therapy approach that focuses on positive reinforcement to promote abstinence from substances and encourage desired behaviors. The core principle of CM lies in the belief that rewarding individuals for meeting treatment goals can effectively reinforce and strengthen positive behaviors. Key elements of CM include:

Rewards System: CM involves providing tangible rewards, such as vouchers, prizes, or privileges, to individuals who achieve specific treatment objectives, such as drug-free urine screens or attendance at therapy sessions. This incentivizes and reinforces abstinence and compliance with treatment goals.

Reinforcing Pro-Social Behaviors: CM extends beyond substance use and incorporates reinforcing alternative, healthy behaviors that align with an individual’s recovery goals. It focuses on enhancing engagement in productive activities, building supportive relationships, and developing life skills.

Personalized Treatment Plans: CM tailors treatment plans to each individual’s needs and preferences. It allows for flexibility in determining the goals, rewards, and frequency of reinforcement, ensuring an approach that resonates with the individual’s motivations and values.

Community Reinforcement Approach (CRA)

Community Reinforcement Approach is a comprehensive treatment model that combines multiple evidence-based strategies to promote long-term recovery and overall well-being. CRA recognizes the importance of creating a supportive environment that reinforces a substance-free lifestyle and includes the following components:

Functional Analysis: CRA involves a comprehensive assessment of the individual’s life and social context, aiming to identify triggers, high-risk situations, and reinforcing factors for substance use. This analysis informs the development of personalized strategies for change.

Skills Training: CRA focuses on building essential life skills to enhance an individual’s overall functioning and increase their ability to cope with challenges. This includes communication skills, problem-solving techniques, job-seeking skills, and relationship-building abilities.

Alternative Reinforcement: CRA emphasizes replacing substance use with healthier and more rewarding alternatives. By providing opportunities for meaningful social connections, enjoyable activities, and employment support, individuals are encouraged to engage in a substance-free lifestyle.

Involvement of Significant Others: CRA recognizes the importance of involving family members, friends, and other significant individuals in the recovery process. By providing support and improving communication within these relationships, CRA aims to strengthen the individual’s social network and reinforce positive behaviors.

Benefits of CM and CRA

Both CM and CRA offer unique advantages as SUD treatment approaches:

Effectiveness: Research has consistently shown positive outcomes for CM and CRA, demonstrating reductions in substance use, improved treatment retention, and enhanced overall functioning.

Customization: CM and CRA allow for individualized treatment plans, recognizing the diverse needs, preferences, and motivations of individuals seeking recovery.

Holistic Approach: By incorporating behavioral interventions, skills training, and environmental support, CM and CRA address multiple facets of an individual’s life, contributing to long-lasting change.

Positive Reinforcement: The use of rewards and reinforcement in CM and CRA fosters motivation, self-efficacy, and a sense of achievement, providing individuals with tangible incentives to maintain their recovery journey.

Contingency Management (CM) and Community Reinforcement Approach (CRA) are two lesser-utilized yet highly effective treatment approaches for Substance Use Disorders (SUD). By leveraging the principles of positive reinforcement, personalized treatment plans, and comprehensive interventions, CM and CRA offer unique benefits in promoting sustained recovery and overall well-being.

While CM focuses on providing rewards for meeting treatment goals and reinforcing pro-social behaviors, CRA takes a broader approach by conducting functional analyses, offering skills training, promoting alternative reinforcement, and involving significant others. Both approaches emphasize customization, recognizing that each individual’s journey to recovery is unique.

One of the significant advantages of CM and CRA is their demonstrated effectiveness. Numerous research studies have consistently shown positive outcomes, including reduced substance use, increased treatment retention, and improved overall functioning. By targeting multiple aspects of an individual’s life, these approaches provide a holistic framework for addressing the complex nature of SUD.

Furthermore, CM and CRA foster motivation and self-efficacy through the use of positive reinforcement. By offering tangible rewards for achieving treatment goals, individuals are encouraged to maintain their progress and continue their journey toward recovery. This not only enhances their motivation but also instills a sense of accomplishment, promoting self-confidence and resilience.

It’s important to note that while CM and CRA have proven effectiveness, they are not standalone treatments. They are often integrated into comprehensive treatment plans that may include other evidence-based approaches, such as medication-assisted treatment (MAT), counseling, and support groups. The integration of these approaches creates a synergistic effect, maximizing the potential for positive outcomes.

Contingency Management (CM) and Community Reinforcement Approach (CRA) offer valuable treatment options for individuals with Substance Use Disorders. These approaches, with their emphasis on positive reinforcement, customization, and comprehensive interventions, contribute to sustained recovery and improved overall well-being. By expanding our knowledge of these lesser-utilized treatments, we can enhance our ability to support individuals on their recovery journey and promote lasting positive change.

Remember to consult with professionals and refer to reputable sources when incorporating CM and CRA into treatment plans. As with any treatment approach, individual needs and preferences should be considered to ensure the best possible outcomes.

Why CM and CRA are Under-Utilized

Both Contingency Management (CM) and Community Reinforcement Approach (CRA) have demonstrated effectiveness in treating Substance Use Disorders (SUD). However, they are still considered relatively under-utilized compared to other more mainstream treatment approaches.

The under-utilization of CM and CRA can be attributed to several factors:

Awareness and Knowledge: While CM and CRA have been researched and proven effective, the level of awareness and knowledge about these approaches among SUD treatment providers and healthcare professionals may be limited. Some professionals may not be familiar with the principles, techniques, and evidence supporting CM and CRA, leading to their under-utilization.

Training and Implementation Challenges: Implementing CM and CRA may require specialized training and support. Not all treatment programs or providers have received training in these approaches, which can hinder their widespread adoption. Limited resources, such as time, funding, and staffing, can also contribute to the challenges of integrating CM and CRA into existing treatment practices.

Traditional Treatment Paradigms: The traditional treatment landscape for SUD has been dominated by approaches such as medication-assisted treatment (MAT) and counseling, which have been widely implemented and well-established. CM and CRA may be perceived as newer or alternative approaches, resulting in slower adoption and incorporation into mainstream practices.

Policy and Reimbursement Barriers: Policies and reimbursement structures within healthcare systems and insurance providers may not fully support or incentivize the implementation of CM and CRA. This can discourage treatment programs from integrating these approaches into their services.

It is important to note that the under-utilization of CM and CRA does not diminish their effectiveness or value as treatment options. With continued research, increased awareness, training opportunities, and policy support, it is possible for these approaches to become more widely recognized and implemented in SUD treatment settings.

By shedding light on these approaches and promoting their benefits, we can contribute to their broader adoption and ensure that individuals with SUD have access to a range of effective treatment options.

Dr. Jessica Rodriguez
LAADC-S, ICAADC, MAC, SUDCCIV-CS, BSP, CTRTC, CIP, CTP, CTS, FSS

Dr. Rodriguez was named the Executive Director of Gateway Corp in 2012.  Gateway Corp was developed as a non-profit, public charity and founded October 27, 2011. November 2014, she developed a clinical hub for Gateway Corp called OnSite Strategies. OnSite is also a United States Trademark.

She has held the position of CEO, Clinical Director, Lead Educator and Clinical Trainer as well as the Clinical Business Developer. She has fulfilled the roles of a clinical consultant, professional development consultant and has clinically supervised many SUD/addiction counselors, mental health professionals and addiction and family interventionists for over 12 years.

She has been active in the mental health field since 1995. She has also clinically trained throughout the US and provides clinical oversight for several organizations in California.

Dr. Rodriguez released her first book, “When the Rainbow Ends a Shadow from Heaven Appears” in 2017.” Her newest book, “The Cart, From Adversity to Collateral Beauty” is scheduled to be released in the Fall of 2022.

Dr. Rodriguez is currently a writer for Rapporteur Magazine. Her focus is about Mental Wellness also covered topics to include ACE’s, trauma, anxiety, and Systemic Racism.

Adriana Popescu, Ph.D.

Dr. Adriana Popescu is a licensed clinical psychologist and empowerment coach with over 25 years of experience in the mental health field. She specializes in treating addictions and trauma, and has directed a number of treatment programs in the San Francisco Bay Area. She is the Founder and CEO of Firebird Healing, a trauma healing program, and the Clinical Director at Avery Lane, an innovative and holistic treatment program for women with co-occurring addiction and mental health disorders and trauma.

Adriana has contributed to a number of books, including TJ Woodward’s Conscious Being Workbook, the Conscious Recovery for Addiction and Conscious Recovery for Mental Health Workbooks, and the Conscious Creation Workbook, all of which she co-authored with him.

She has a private practice in San Francisco and travels around the world speaking, coaching, and facilitating transformational and empowering workshops. She also hosts a fascinating podcast called Kaleidoscope of Possibilities – Alternative Perspectives on Mental Health.

Adriana loves to bring the most innovative and effective tools to her work, empowering people to overcome their imagined limitations, release their self-judgments, and discover the brilliance within – creating a life of infinite possibilities.

Her first book, “What If You’re Not as F*cked Up As You Think”, was released in October.

Aven Armstrong-Sutton, Ph.D(c), RSW

Clinical Services Manager at Kinark Child and Family Services

Aven L. Armstrong-Sutton has been a practicing licensed social worker for over a decade. With diverse experience in settings such as health promotion, foster care, youth homelessness, outpatient mental health & addictions, and student support services, Aven currently serves as a Clinical Services Manager at Kinark Child and Family Services, managing a Live-In-Treatment Program and three outpatient treatment programs. Maintaining a part-time private practice, Aven’s multidisciplinary and integrative approach focuses on trauma and resilience among under-served communities.

June Price Tangney, Ph.D

Dr. Tangney received her Ph.D. in clinical psychology from UCLA. She is currently University Professor and Professor of Psychology at George Mason. She is a Recipient of International Society for Self and Identity’s Distinguished Lifetime Career Award and Fellow of the Association of Psychological Science and of APA’s Division of Personality and Social Psychology.

Dr. Tangney is coauthor (with Ronda Dearing) of Shame and Guilt, coeditor (with Ronda Dearing) of Shame in the Therapy Hour, coeditor (with Jess Tracy and Richard Robins) of The self-conscious emotions: Theory and research, and coeditor (with Mark Leary) of the Handbook of Self and Identity. She has served as Associate Editor for Self and Identity, Consulting Editor for Journal of Personality and Social Psychology, Personality and Social Psychology Bulletin, Psychological Assessment, Journal of Social and Clinical Psychology, and Journal of Personality, and is currently Associate Editor of American Psychologist.

Her research on the development and implications of moral emotions has been funded by NIDA, NICHD, NSF, and the John Templeton Foundation. Currently, her work focuses on moral emotions among incarcerated offenders. She draws on theory and research in psychology and criminology to develop novel interventions that leverage inmates’ moral emotions and prosocial values. A recipient of GMU’s Teaching Excellence Award, Dr. Tangney strives to integrate service, teaching and clinically-relevant research in both the classroom and her lab.

Christina Veselak, MS, LMFT, CN

Founder and Director of the Academy for Addiction and Mental Health Nutrition

Christina T. Veselak, MS, LMFT, CN, is the founder and director of the Academy for Addiction and Mental Health Nutrition, which teaches practitioners around the world how to use diet, along with amino acid and nutrient therapy, to help prevent cravings and recurrent drug use. She has been a licensed psychotherapist working in the SUD treatment field since 1985 and a certified nutritionist specializing in mental health and addiction recovery since 1993.

Sean Bezdek, LMFT, MBA

Sean is a licensed Marriage and Family Therapist with over 25 years of experience working in mental health and substance abuse settings, in inpatient, PHP, and private practice. He holds b a master’s degree in Marital and Family Therapy from Philips Institute and an MBA from Baker College.

Sean’s clinical practice has specialized in working with Personality Disorders, Couples, Adolescents, and individual suffering from chronic mental illness. As a clinician Sean enjoys working with clients who can be resistant to traditional treatment and believes in the philosophy of “You can lead a horse to water, but you can’t make them drink. BUT you can feed them saltines to make them thirsty!”

Sean is the Program Director for Akua Mind Body’s Sacramento inpatient mental health program. His prior leadership experience includes oversight of acute inpatient, utilization management, hospice/palliative care, home health and skilled nursing. Sean’s approach to management is to ensure the work that needs to get done gets done. “Our job is patient care. This include everything from making coffee to running groups. There is not one person who is more important that the other when it comes to providing exceptional care to the clients we serve.”